Individual
BRIAN HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
203 BAILEY LN STE 1, BENTON, IL 62812-2266
(618) 438-5670
(618) 438-5709
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 438-5670
(618) 438-5709
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036111745
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111745
—
IL
Enumeration date
04/07/2006
Last updated
04/04/2022
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